WA Oaths, Affidavits and Statutory Declarations Act 2005 & Commonwealth Statutory Declarations Act 1959

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1 Statutory Declaration WA Oaths, Affidavits and Statutory Declarations Act 2005 & Commonwealth Statutory Declarations Act 1959 FAX ADDRESS PO box 4306, NORTH CURL CURL, nsw 2099 Your COURSE will not be ASSEssed unless 1. all three sections of this Statutory Declaration are completed in full. 2. a photocopy of your photographic ID, that has been signed by a JP is attached. I, NAME of ADDRESS in the State of APPLICANT make the following declaration under the Statutory Declarations Act 1959 (Commonwealth) and do solemnly and sincerely declare that in accordance with WA Oaths, Affidavits and Statutory Declarations Act 2005 that: 1. I have identified myself truthfully for the course undertaken. 2. The work submitted during the course was my own work. 3. I have received no assistance from anyone else (other than the trainer of the course) in the completion of the assessment. 4. I T will provide a short VIDEO recording of myself putting on Personal Protective Equipment (PPE) stating my full name and the purpose of each item of PPE. I will provide an AUDIO/VIDEO recording of the attached questions. You will need FaceTime (IPhone) or download 1 of the following free APPS. WhatsAPP, Viber, Skype. Call Peter on through one of these apps to record your answers. I understand that someone from absolute education may call me within the next 4-weeks to verify my card details. and I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the Oaths Act 2005 WA. I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959 C wlth, and I believe that the statements in this declaration are true in every particular. SIGNATURE PLEASE KEEP SIGNATURE INSIDE BOX JP Note: This section must be signed by a registered Justice of the Peace, Commissioner for Declarations, or legal practitioner. Justice of the Peace Commissioner for Declarations Legal Practitioner Taken and declared before me at this day, of the month of of the year Print full name, qualification and address of the person before whom the declaration is made. APPLICANT s DRIVER S LICENCE Place your driver s licence or other photo identification here. STAMP HERE If your ID doesn t fit here, you will need to make a copy on a separate blank sheet. SIGNATURE DECLARATION BY WITNESS (A witness is someone who can verify it was you who completed the course. This can be a spouse or family member.) I, NAME of ADDRESS in the State of WITNESS Contact number do solemely and sincerely declare that I am over the age of 18 years and that: I am the declarant, observed the course participant undertaking the course assessment; that the course participant is one and the same person as the person who undertook the course assessment on the said time, date and place of the assessment; the mode of course assessment undertaken was online; the residential address and telephone numbers (if any) of the declarant are correct; I, as the declarant know that it is an offence to make the declaration should it be false in any materials particular. And I make this declaration conscientiously believing the same to be true. Signature of the declarant/despondent (the Witness) SIGNATURE Note 1: A person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the punishment for which is imprisionment for a term of four years see section 11 of the Statutory Declarations Act Note 2: Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959 see section 5A of the Statutory Declarations Act 1959.

2 INSTRUCTIONS There are 4 steps to receive your White-Card from ABSOLUTE Education. Step 1. Answer the online questions. Step 2. Provide your ID and completed statutory declaration with your signature. Step 3. Visually Record yourself putting on PPE Gear (hardhat, eyewear, earplugs/muffs & high-visibility top). Step 4. Please either FACETIME, SKYPE, VIBER or WHATSAPP Peter on so we can record your voice and face answering the following set of questions. These are free Apps that can be downloaded onto your phone. When recording your answers, please 1. Please call Peter on using one of the apps mentioned above. 2. State your full name at the beginning of the recording. 3. Make it clear ORALLY (speaking with your voice) which of your answers you have chosen. 4. You can use the orange boxes as a guide of what needs to be said.

3 1. CONSTRUCTION HAZARDS a. Name 2 construction hazards and how you could reduce the risk of each hazard? Options: unsafe or unsecure scaffolding. Options: unsafe or improper use of ditches. Options: risk of electrocution. b. What protective gear or equipment can you use to control the risk? Options: Kickboards, wall anchors, harness, tether, Hardhat, Eye-wear, boots, mask, Safety-suit, gloves, perimeter fencing, stand-over person. A construction hazard can be something like unsafe scaffolding or a large hole with no side protection. To reduce the risk of unsafe scaffolding I would use safety harnesses where possible, kickboards to prevent falling objects. Also the use of wall anchors to prevent collapse or swaying. For a large hole, I would use Side protection or perimeter fencing around the ditch and The use of a Stand over person.

4 2. FIRE EQUIPMENT AND RESPONSES a. If a person was to catch on fire, and you had access to a fire blanket, what order of steps would you take to assist them. b. Which of the following extinguishers would best be suited for an electrical fire? Options: Powder, CO2, Water, Foam, Wet Chemical. c. Which of the following extinguishers would best be suited for a wood fire? Options: Powder, CO2, Water, Foam, Wet Chemical. d. Which of the following extinguishers would best be suited for a chemical fire? Options: Powder, CO2, Water, Foam, Wet Chemical. If one of my colleagues was to catch on fire, the order of steps I would take to assist them is to 1. Get them to drop to the floor. 2. Wrap them in the fire blanket. 3. Get them to roll and roll. 4. Call for help. 5. Administer First Aid to the best of my knowledge. If there was an electrical fire (TYPE E), I would use the P extinguisher. If there was a wood fire (TYPE A), I would use the W extinguisher. If there was a cooking oil fire (TYPE F), I would use the W extinguisher.

5 3. OHS PERSONNELL a. Identify each of the roles below with the appropriate health and safety person. WHO IS, a worker who represents the health and safety interests of workers within their workgroup and must work within the organisation. WHO is responsible for monitoring and maintaining first aid facilities in their office, administering first aid and assisting the WHS Site Officer. WHO sets performance standards for tasks, jobs and roles of their employees and oversee or ensure employees have appropriate and realistic jobs and responsibilities. Can act as a mentor. WHO facilitates the co-operation between PCBU and workers to instigate, develop and carry out measures to ensure the health and safety workers. The person who represents the health and safety interests of workers within their workgroup and must work within the organisation is known as the. The person who is responsible for monitoring and maintaining first aid facilities in their office, administering first aid and assisting the WHS Site Officer is known as the. The Person whose role is to set performance standards for tasks, jobs and roles is referred to as the. The person who facilitates the co-operation between PCBU and workers to instigate, develop and carry out measures to ensure the health and safety workers is known as.

6 4. IDENTIFY SAFETY SIGNS a. Blue signs usually have what kind of meaning? Options: Danger, Mandatory, Emergency, Warning, Prohibit. b. Green signs usually denote what meaning? Options: Danger, Mandatory, Emergency, Warning, Prohibit. c. What colour are warning signs usually? Options: Red, Green, Blue, Yellow, White. d. What would you use a red sign with a line through it for? Options: Danger, Mandatory, Emergency, Warning, Prohibit. If I was to see a blue sign with a hardhat, this would mean that I must wear that hard hat. It is a MA sign. Emergency signs are usually GR in colour. Warning signs are usually YEL in colour. Signs that are in RED in colour and have a cross through them usually denote that they MUST/MUST NOT be done or are PRO.

7 5. JSA s SWMS & SDS a. What document would I refer to if I was to come across an unknown or dangerous chemical or substance? Options: Job Safety Analysis (JSA). Safe Work Method Statement (SWMS). Safety Data Sheet (SDS). b. Explain the difference between a Safe Work Method Statement (SWMS) and a and a Job Safety Analysis (JSA)? Options: Deals with a particular task or job. Deals with procedures to carry out a task. Deals with substances. JSA integrates safety and health principles for a particular task or job. SWMS deal with the procedures of how to carry out tasks in a safe manner. SDS deal with substances. (formerly MSDS Material) A JSA, SWMS & SDS are all documents. The difference between them is that The safety and health principles for a particular task are contained in the J whereas the procedure or method of how to carry out a task in a safe manner is contained within the SW while chemicals, substance or dangerous materials and how to store or use them are outlined in the S.